Multi-barrel drill guide and anchor deployment assembly

ABSTRACT

A method for suspension of the CMC joint that minimizes patient irritation/discomfort and damage to the surrounding tissue. Specifically, the method is a method for suspending a first metacarpal in relative position to a second metacarpal. The method includes the steps of: (i) drilling a hole through the first metacarpal; (ii) inserting a drill guide through the hole in the first metacarpal; (iii) advancing the drill guide to a surface of the second metacarpal, and drilling a hole in the second metacarpal; (iv) inserting an anchor into the hole formed in the second metacarpal, wherein the anchor is attached to suture; (v) deploying the anchor within the second metacarpal; (vi) tensioning the suture attached to the anchor; and (vii) fixing the position of the first metacarpal relative to the second metacarpal using the suture.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims priority to and the benefit of U.S.Provisional Patent Application No. 62/742,716, filed on Oct. 8, 2018 andhereby incorporated by reference herein in its entirety. The presentapplication relates to PCT App. No. PCT/US18/36011 filed on Jun. 5,2018, which claims priority to and the benefit of U.S. ProvisionalPatent Application No. 62/515,033, filed on Jun. 5, 2017, U.S.Provisional Patent Application No. 62/515,082, filed on Jun. 5, 2017,U.S. Provisional Patent Application No. 62/516,733, filed on Jun. 8,2017, U.S. Provisional Patent Application No. 62/618,817, filed on Jan.18, 2018, and U.S. Provisional Patent Application No. 62/649,181, filedon Mar. 28, 2018, each of which is hereby incorporated by reference intothis document in their respective entirety(ies).

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates to drills, anchor drivers, and a drillguide for drilling a pilot hole at a surgical repair site and insertinga suture anchor in the pilot hole and, more particularly, to a methodfor suspension of the CMC joint that minimizes patientirritation/discomfort and damage to the surrounding tissue.

2. Description of Related Art

Many orthopedic surgical and medical procedures require the fixation ofone body to another body. Such bodies may include bone, soft tissue, andprosthetics. One body can be fixed in a position relative to anotherusing connector devices, such as screws and suture anchors (e.g.,cannulated knotless suture anchors and soft all suture anchors). Forexample, various orthopedic surgeries require the insertion and fixationof a suture anchor within a bone. In such surgeries, prior to insertionof a suture anchor, a pilot hole is drilled into the bone.Traditionally, a standard single barrel drill guide is placed at thedesired pilot hole location on the bone and a drill is placed throughthe drill guide to create the pilot hole. The drill is then removed andreplaced with a driver pre-loaded with the suture anchor. Thus, asurgeon must completely remove the drill from the drill guide and insertthe driver all while maintaining alignment of the drill guide with thepilot hole.

Exchanging tools within the drill guide after creation of the pilot holeincreases the risk that the alignment of the drill guide with the pilothole will be lost. A loss of alignment requires additional surgical timeto correct the misalignment, if even possible, and may potentiallyresult in trauma to the tissue or bone surrounding the pilot hole. Lossof alignment can also result in the anchor inserter rod bending or theanchor not being able to insert fully into the pilot hole which can addcost as well as surgical time. To avoid misalignment with a standardsingle barrel guide, an additional assistant may be required to helpmaintain alignment or attempt realignment.

In addition, traditional suture anchors deployed by conventional driversare often too large for procedures that involve soft tissue fixation inthe extremities. A bone hole drilled in an extremity must be shallow andhave a narrow diameter due to the very nature of the location of theprocedure. A shallow bone hole requires that the anchor have exceptionalretention capacity, because any movement of the anchor away from theshallow bone hole might entirely release the anchor from the bone hole.At the very least, the anchor may extend out of the shallow and narrowbone hole. Ill-fitting suture anchors have increased instability and cancause irritation or damage to tissue surrounding the exposed portion ofthe anchor.

Attempts at addressing the problem include scaling down the size of atraditional suture anchor to fit within a shallow and narrow bone hole.However, as the size of the traditional suture anchor decreases, theanchor loses retention capacity and thus is unstable within the bonehole. Although numerous factors can influence the retention capacity ofa suture anchor, such as the type of tissue, the size of the bone hole,and the anchor's design, the method of deployment of the suture anchorcan also influence a suture anchor's retention capacity.

In an exemplary procedure, a suspension arthoplasty for thumb arthritisrequires suspension of the CMC joint between the first metacarpal (i.e.,thumb bone) and the second metacarpal (i.e. index finger bone).Currently, the suspension of the CMC joint is performed by first,drilling a tunnel between the first metacarpal and the secondmetacarpal, and then, using a pair of metal buttons with suture tied inbetween. According to the current method for suspension, a metal buttonis on both a medial side of the second metacarpal and a lateral side ofthe first metacarpal. The number of buttons, especially including themedially positioned button, increases the risk for irritation/discomfortto the patient and damage to the surrounding tissue.

Therefore, there is a need for a method for suspension of the CMC jointthat minimizes patient irritation/discomfort and damage to thesurrounding tissue.

Description of the Related Art Section Disclaimer: To the extent thatspecific patents/publications/products are discussed above in thisDescription of the Related Art Section or elsewhere in this disclosure,these discussions should not be taken as an admission that the discussedpatents/publications/products are prior art for patent law purposes. Forexample, some or all of the discussed patents/publications/products maynot be sufficiently early in time, may not reflect subject matterdeveloped early enough in time and/or may not be sufficiently enablingso as to amount to prior art for patent law purposes. To the extent thatspecific patents/publications/products are discussed above in thisDescription of the Related Art Section and/or throughout theapplication, the descriptions/disclosures of which are all herebyincorporated by reference into this document in their respectiveentirety(ies).

BRIEF SUMMARY OF THE INVENTION

The present disclosure is directed to a method for suspension of the CMCjoint that minimizes patient irritation/discomfort and damage to thesurrounding tissue. According to an aspect, the present invention is amethod for suspending a first metacarpal in relative position to asecond metacarpal. The method includes the steps of: (i) drilling a holethrough the first metacarpal; (ii) inserting a drill guide through thehole in the first metacarpal; (iii) advancing the drill guide to asurface of the second metacarpal, and drilling a hole in the secondmetacarpal; (iv) inserting an anchor into the hole formed in the secondmetacarpal, wherein the anchor is attached to suture; (v) deploying theanchor within the second metacarpal; (vi) tensioning the suture attachedto the anchor; and (vii) fixing the position of the first metacarpalrelative to the second metacarpal using the suture.

According to another aspect, the method also includes the steps ofattaching a fixation device to the suture and advancing the fixationdevice along the suture to over the hole in the first metacarpal. Themethod may also include the steps of deploying the fixation device overthe hole in the first metacarpal and/or tying a knot in the sutureproximal to the fixation device.

According to yet another aspect, the method also includes the step oftying a knot in the suture proximal to the hole in the first metacarpal.

According to an alternative aspect, the method includes the step oftying the suture to at least one of a ligament or a tendon.

According to other aspects, the fixation device is an all-suture buttonand/or the anchor is an all-suture anchor. Further, the drill guide mayinclude an anchor driver extending therethrough and the anchor is loadedonto the anchor driver prior to insertion in the hole of the firstmetacarpal. Additionally, the method step of deploying the anchor withinthe second metacarpal may also include the step of pulling the suture ina proximal direction using a feature of the drill guide.

Suture material or sutures, as the terms are used and described herein,can include monofilament or multi-filament suture as well as any othermetallic or non-metallic filamentary or wire-like material suitable forperforming the function of a suture. This material can include bothbioabsorbable and non-absorbable materials.

Suture anchors, as the term is used herein, can include soft sutureanchors and rigid suture anchors. Soft suture anchors are formed fromfilaments of suture material which are retained within pre-formed boneholes by being deformable to increase their diameter to a size greaterthan that of the bone hole, to thereby reside within the cancellous boneand under the bone cortex. One such suture anchor is disclosed in U.S.Pat. No. 9,826,971 assigned to the assignee hereof and incorporated byreference herein in its entirety. Since soft anchors are commonly madeentirely of suture materials, they are sometimes called “all-suture”anchors, and generally include a fibrous construct anchor body portion(or fibrous, braided or woven fabric-type structure such as a flexibleweb, as described in U.S. Pat. No. 9,173,652) and a suture or filamentportion. Methods and devices for inserting/deploying such all-sutureanchors are known, examples of which are disclosed in U.S. Pat. No.9,173,652.

As described in U.S. Pat. No. 8,409,252, for example, “non-soft,” “hard”or “rigid” suture anchors generally include a “hard” anchor body portion(that may or may not include inner and outer members) and asuture/filament portion. The anchor body of such suture anchors may beformed of a biocompatible and/or bioabsorbable material. These materialsmay be of such composition that they are reabsorbed by the body, e.g.,during the healing process of the bone. Exemplary materials that aresuitable for use in the inner and outer members include, but are notlimited to, polyetheretherketone (“PEEK”), polylacticacid/beta-tricalcium phosphate (“PLA/Beta-TCP”) composites, ultra-highmolecular weight polyethylene (“UHMWPE”), as well as other metallic,non-metallic, and polymeric materials.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING(S)

The present invention will be more fully understood and appreciated byreading the following Detailed Description in conjunction with theaccompanying drawings. The accompanying drawings illustrate only typicalembodiments of the disclosed subject matter and are therefore not to beconsidered limiting of its scope, for the disclosed subject matter mayadmit to other equally effective embodiments. Reference is now madebriefly to the accompanying drawings, in which:

FIG. 1 is a first side view schematic representation of a multi-barreldrill guide and anchor deployment assembly in the pre-drill, pre-anchordeployment, pre-actuated configuration according to an embodiment;

FIG. 2 is a first side view schematic representation of a multi-barreldrill guide and anchor deployment assembly in the drill, pre-anchordeployment, pre-actuated configuration according to an embodiment;

FIG. 3 is a cross-sectional first side view schematic representation ofthe multi-barrel drill guide and anchor deployment assembly of FIG. 2according to an embodiment;

FIG. 4 is a close-up cross-sectional first side view schematicrepresentation of a locking mechanism of the multi-barrel drill guideand anchor deployment assembly of FIG. 2 according to an embodiment;

FIG. 5 is a cross-sectional front/perspective view schematicrepresentation of the locking mechanism of the multi-barrel drill guideand anchor deployment assembly of FIG. 2 according to an embodiment;

FIG. 6 is a close-up second side view schematic representation of anotch of the locking mechanism of the multi-barrel drill guide andanchor deployment assembly of FIG. 2 according to an embodiment;

FIG. 7 is a first side view schematic representation of a multi-barreldrill guide and anchor deployment assembly in the post-drill, pre-anchordeployment, pre actuated configuration according to an embodiment;

FIG. 8 is a close-up cross-sectional first side view schematicrepresentation of the second channel of the multi-barrel drill guide andanchor deployment assembly of FIG. 7 according to an embodiment;

FIG. 9 is a close-up first side view schematic representation of theshallow deployment button of multi-barrel drill guide and anchordeployment assembly in the pre-actuated/undeployed configurationaccording to an embodiment;

FIG. 10 is a close-up cross-sectional second side view schematicrepresentation of the shallow deployment button of the multi-barreldrill guide and anchor deployment assembly of FIG. 9 according to anembodiment;

FIG. 11 is a close-up first side view schematic representation of theshallow deployment button of multi-barrel drill guide and anchordeployment assembly actuated/undeployed configuration according to anembodiment;

FIG. 12 is a close-up rear/perspective view schematic representation ofthe shallow deployment button of FIG. 11 according to an embodiment;

FIG. 13 is a rear view schematic representation of the shallowdeployment button of FIG. 11 according to an embodiment;

FIG. 14 is a first side view schematic representation of the anchordriver of the multi-barrel drill guide and anchor deployment assembly inthe actuated/undeployed configuration according to an embodiment;

FIG. 15 is a close-up review view schematic representation of theproximal ends of the sliding inserter and elongated body of FIG. 14according to an embodiment;

FIG. 16 is a close-up first side view schematic representation of theproximal ends of the sliding inserter and elongated body of FIG. 14according to an embodiment;

FIG. 17 is a close-up first side view schematic representation of thesuture anchor in the undeployed state on the anchor driver of themulti-barrel drill guide and anchor deployment assembly according to anembodiment;

FIG. 18 is a first side view schematic representation of the shallowdeployment button of multi-barrel drill guide and anchor deploymentassembly in the actuated/deployed configuration according to anembodiment;

FIG. 19 is a close-up side/rear perspective view schematicrepresentation of the shallow deployment button of FIG. 18 according toan embodiment;

FIG. 20 is a close-up first side view schematic representation of thesuture anchor in the deployed state on the anchor driver of themulti-barrel drill guide and anchor deployment assembly according to anembodiment;

FIG. 21 is a close-up side view schematic representation of the sutureanchor of FIG. 20 with the multi-barrel drill guide and anchordeployment assembly removed according to an embodiment;

FIG. 22 is a side view schematic representation of an embodiment of thesuture anchor in the undeployed configuration according to anembodiment;

FIG. 23 is a side view schematic representation of the suture anchor ofFIG. 22 loaded onto the anchor drive according to an embodiment r;

FIG. 24 is a side view schematic representation of the suture anchor ofFIG. 22 loaded onto the anchor driver and placed in a pilot holeaccording to an embodiment;

FIG. 25 is a side view schematic representation of the suture anchor ofFIG. 22 between the undeployed and deployed configurations according toan embodiment;

FIG. 26 is another side view schematic representation of the sutureanchor of FIG. 22 between the undeployed and deployed configurationsaccording to an embodiment;

FIG. 27 is a final side view schematic representation of the sutureanchor of FIG. 22 between the undeployed and deployed configurationsaccording to an embodiment;

FIG. 28 is a side view schematic representation of the suture anchor ofFIG. 22 in the deployed configuration according to an embodiment;

FIG. 29 is a side view schematic representation of the suture anchor ofFIG. 22 in the fully deployed configuration according to an embodiment;

FIG. 29A is a side view schematic representation of a suture anchorloaded onto the anchor driver according to an alternative embodiment;

FIG. 29B is a side view schematic representation of the suture anchor ofFIG. 29A loaded onto the anchor driver in the partially deployedconfiguration according to an alternative embodiment;

FIG. 29C is a side view schematic representation of the suture anchor ofFIG. 29A loaded onto the anchor driver in the fully deployedconfiguration according to an alternative embodiment

FIG. 30 is a first side view schematic representation of an alternativeembodiment of the multi-barrel drill guide and anchor deploymentassembly in the pre-drill, pre-anchor deployment, pre-actuatedconfiguration according to an embodiment;

FIG. 31 is a first side view schematic representation of themulti-barrel drill guide and anchor deployment assembly of FIG. 30 inthe drill, pre-anchor deployment, pre-actuated configuration accordingto an embodiment;

FIG. 32 is a first side view schematic representation of themulti-barrel drill guide and anchor deployment assembly of FIG. 30 inthe post-drill, pre-anchor deployment, pre-actuated configurationaccording to an embodiment;

FIG. 33 is a first side view schematic representation of themulti-barrel drill guide and anchor deployment assembly of FIG. 30 inthe post-drill, actuated/deployed configuration with the suture anchorin the deployed state according to an embodiment;

FIG. 34 is a first side view schematic representation of the sutureanchor of FIG. 33 in the deployed state according to an embodiment;

FIG. 35 is a side view schematic representation of an additionalembodiment of the suture anchor in the undeployed state according to anembodiment;

FIG. 36 is a side view schematic representation of the suture anchor ofFIG. 35 shortened and expanded in the deployed state according to anembodiment;

FIG. 37 is a side view schematic representation of a disposable drillwith a pre-installed drill bit according to an alternative embodiment;

FIG. 38 is a schematic representation of an all suture soft tissuefixation device according to an embodiment:

FIG. 39 is a side view schematic representation of an anchor driveraccording to an alternative embodiment;

FIG. 40 is a side view schematic representation of a portion of theanchor driver of FIG. 39;

FIG. 41 is a perspective view schematic representation of a spoolportion of the anchor driver of FIG. 39;

FIG. 42 is a perspective view schematic representation of a safety barportion of the anchor driver of FIG. 39;

FIG. 43 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 39;

FIG. 44 is a top view schematic representation of a portion of theanchor driver of FIG. 39;

FIG. 45 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 39;

FIG. 46 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 39;

FIG. 47 is a side perspective view schematic representation of a fullyassembled anchor driver of FIG. 39;

FIG. 48 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 47;

FIG. 49 is a side view schematic representation of a portion of theanchor driver of FIG. 47;

FIG. 50 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 47;

FIG. 51 is a side view schematic representation of a portion of theanchor driver of FIG. 47;

FIG. 52 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 47;

FIG. 53 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 47;

FIG. 54 is a top perspective view schematic representation of a portionof the anchor driver of FIG. 47;

FIG. 55 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 47;

FIG. 56 is a perspective view schematic representation of an anchor in afully deployed configuration/position/state;

FIG. 57 is a side view schematic representation of an anchor driveraccording to an alternative embodiment;

FIG. 58 is a side view schematic representation of a fully assembledanchor driver of FIG. 57;

FIG. 59 is a side perspective view schematic representation of theanchor driver of FIG. 57;

FIG. 60 is a side perspective view schematic representation of theanchor driver of FIG. 57;

FIG. 61 is a side perspective view schematic representation of a portionof the anchor driver of FIG. 57;

FIG. 62 is a perspective view schematic representation of an anchor in afully deployed configuration/position/state;

FIG. 63 is a top view schematic representation of a drill guideextending through a first metacarpal, according to an embodiment;

FIG. 64 a top view schematic representation of suture tensioned betweenthe first metacarpal and the second metacarpal, according to anembodiment;

FIG. 65 a top view schematic representation of a button fixed over thefirst metacarpal, according to an embodiment;

FIG. 66 is a side view schematic representation of an all-suture buttonin the expanded position, according to an embodiment; and

FIG. 67 is a side view schematic representation of the deployedconfiguration of the all-suture button, according to an embodiment.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to the drawings, wherein like reference numerals refer tolike parts throughout, there is seen in FIG. 1 a fully assembled firstside 103 view schematic representation of a multi-barrel drill guide andanchor deployment assembly 100 in the pre-drill, pre-anchor deployment,pre-actuated configuration according to an embodiment. In the depictedembodiment, the assembly 100 includes, but is not limited to, a distalelongated body 102 extending along a central longitudinal axis x-xhaving a proximal end 104 and a distal end 106, a handle 108 (which caninclude gripping features 109) extending from the elongated body 102between the proximal end 104 and a distal end 106, a distal tube orguide tip 128 (which can include gripping projections or teeth to assistwith setting and maintaining position on bone) extending from the distalend 106, and a proximal sliding inserter/anchor driver 118/114. Theelongated body 102 has an exterior, portions of which are sufficientlyenclosed (as described above and shown in the FIGS.). The exteriorportion of the elongated body 102 preferably comprises no movable partsthat complicate or interfere with easy use of the assembly 100.

As shown in FIG. 1, the handle 108 extends approximately perpendicularfrom the elongated body 102 between the proximal end 104 and the distalend 106 to increase balance and control of the assembly 100. However,the handle 108 may extend at various angles relative to the centrallongitudinal axis x-x, from any location along the elongated body 102,to provide stability when the user grips the handle 108 to place theassembly 100 against a desired pilot hole location on a bone.

Still referring to FIG. 1, the elongated body 102 comprises a slot 120extending in a proximal direction along an axis parallel to the centrallongitudinal axis x-x from the distal end 106 through at least a distalportion of the elongated body 102, through a first opening 107 (formedin the top of the handle 108 and/or in the elongated body 102) and to asecond larger opening 111 (formed in the top of the handle 108 and/or inthe elongated body 102) which extends to the proximal end 104. The slot120 and openings 107, 111 can extend along an axis perpendicular to thecentral longitudinal axis x-x and through the elongated body 102 into afirst channel 110 (see FIG. 5) to the inside of a second side 105 of theassembly 100.

As shown in FIG. 1, a track 113—including a first portion 113Apositioned along the inside of a second side 105, and second portion113B positioned along the bottom inside of the elongated body102—extends in a distal direction along an axis parallel to the centrallongitudinal axis x-x from the proximal end 104 toward the distal end106, ending at or before the distal end 106. The track 113 facilitatesthe movement of the proximal sliding inserter 118 along an axis parallelto the central longitudinal axis x-x from the proximal end 104 throughat least a distal portion of the elongated body 102 (as described indetail below).

The sliding inserter 118 comprises an anchor driver 114 attached thereto(shown in FIGS. 5 and 10). In a pre-actuated/undeployed configuration,the anchor driver 114 of the sliding inserter 118 extends from theproximal end 104 of the elongated body 102 through at least a distalportion of the elongated body 102. However, in itspre-actuated/undeployed configuration, the anchor driver 114 does notextend into the distal tube or guide tip 128 (shown in FIG. 8). Whenfully assembled, the multi-barrel drill guide and anchor deploymentassembly 100 comprises a suture anchor 10 with a passing filament 11loaded on the anchor driver 114 (described in detail later). As fullyassembled, the suture anchor 10 is loaded on distal end 115 of theanchor driver 114, while the passing filament 11 extends along thelength of the anchor driver 114 and is wrapped around or otherwisesecured by a loading mechanism 117 at a proximal end 119 of the slidinginserter 118 (also shown in FIGS. 5 and 12). The proximal end can alsoinclude a malleting section or area on the back surface of the proximalend. This malleting section can provide a user with a surface to malletand assist with setting and maintaining the distal end of the guide tube128 in bone prior to drilling the hole. In the depicted embodiment, theloading mechanism 117 includes one or more notches 121 and a flexiblesubstrate 122. In one embodiment, the flexible substrate 122 is composedof a foam material; however, any other semi-flexible material may beused. The flexibility of the flexible substrate 122 is such that theflexible substrate 122 may be easily removed from the sliding inserter118 to free the passing filament 11 (which may or may not be attached toneedles, as should be understood by a person of skill in the art inconjunction with a review of this disclosure). As shown, the flexiblesubstrate 122 is sized or otherwise dimensioned to fit within a portionof the proximal end 119 of the sliding inserter 118. In the depictedembodiment, the passing filament 11 is removably secured by the one ormore notches 121 and the flexible substrate 122 to allow for release ofthe suture anchor 10 from the assembly 100 when the suture anchor 10 isin a deployed state in a pilot hole.

Still referring to FIG. 1, the sliding inserter 118 also comprises anopening 123 configured to receive a drill bit 116. In the depictedembodiment, the opening 123 is located or otherwise positioned at adistal end 124 of the sliding inserter 118. In the pre-drillconfiguration (FIG. 1) and drill configuration (FIGS. 2-3), the opening123 on the sliding inserter 118 is aligned with an opening 125 on theelongated body 102. The opening 125 is located or otherwise positionedbetween the proximal end 104 and the distal 106 of the elongated body102 and connects to a second channel 112 within the elongated body 102.Thus, in the pre-drill configuration shown in FIG. 1, the drill bit 116extends through the opening 123 in the sliding inserter 118 and into theopening 125 of the elongated body 102. In the drill configuration (shownin FIGS. 2-3 and described in detail below), the drill bit 116 isadvanced into the second channel 112 of the elongated body 102 andthrough the connected distal tube or guide tip 128. In comparison, inFIG. 1, the assembly 100 is in a pre-drill configuration wherein thedrill bit 116 extends only partially through the second channel 112 andnot through the distal tube or guide tip 128.

Turning now to FIG. 2, there is shown a fully assembled first side 103view schematic representation of a multi-barrel drill guide and anchordeployment assembly 100 in the drill, pre-anchor deployment,pre-actuated configuration according to an embodiment. In the depictedembodiment, the drill bit 116 is in the drill configuration such thatthe drill bit 116 extends through the second channel 112 at a lengthcorresponding to the desired or proper depth for the pilot hole. In theembodiment shown, the drill bit 116 comprises a depth stop 126 at itsproximal end 127, which abuts the opening 123 in the sliding inserter118 when the drill bit 116 has reached the proper depth in the pilothole. The depth stop 126 prevents the drill bit 116 from extending anydeeper into the bone than the proper depth for the pilot hole in aparticular procedure. Similarly, the depth stop 126 also allows the userto determine if the drill bit 116 has been advanced far enough into thebone. As shown in FIG. 2, in the drill configuration, the distal end 129of the drill bit 116 extends out from the distal tube or guide tip 128in order to drill the pilot hole.

Referring now to FIG. 3, there is shown a cross-sectional first side 103view schematic representation of the multi-barrel drill guide and anchordeployment assembly 100 of FIG. 2. In the depicted embodiment, theelongated body 102 comprises the first channel 110 and the secondchannel 112 for receiving tools to drill the pilot hole and to insertthe suture anchor 10. As shown in FIG. 3, the first channel 110 extendsfrom proximal end 104 to the distal end 106 of the elongated body 102,while the second channel 112 extends from the opening 125 on theelongated body 102 to the distal end 106. Thus, in the depictedembodiment, the first channel 110 and the second channel 112 havedifferent entry points along the elongated body 102. The two separateentry points accommodate the two tools—the drill bit 116 for drillingthe pilot hole and the anchor driver 114 for inserting the suture anchor10 into the drilled pilot hole.

As recited above, the first channel 110 extends approximately straightin a distal direction along an axis parallel to the central longitudinalaxis x-x of the elongated body 102 from the proximal end 104 to distalend 106. The second channel 112 extends at an angle relative to thefirst channel 110 and to the central longitudinal axis x-x, which allowsthe first channel 110 and the second channel 112 to have separate entrypoints and one convergence area 130. Thus, although the first channel110 and the second channel 112 extend from different entry points alongthe elongated body 102, the first channel 110 and the second channel 112share a convergence area 130 proximal to a single exit point on thedistal end 106 of the elongated body 102. In other words, theconvergence area 130 is where the channels 110, 112 converge prior(i.e., proximal) to the single exit point. In the depicted embodiment,the single exit point is at a distal end 131 of the distal tube or guidetip 128.

Accordingly, the first channel 110 is separate and distinct from thesecond channel 112 between the entry points and the convergence area130. Thus, a user can employ the drill bit 116 in the second channel 112by extending the drill bit 116 into the convergence area 130 and out ofthe distal tube or guide tip 128, while the anchor driver 114 can sit(be positioned and not move) in the first channel 110. As shown in FIG.3, the drill bit 116 is in the drill configuration with the distal end129 of the drill bit 116 extending from the distal tube or guide tip 128and the depth stop 126 abutting the opening 123 on the sliding inserter118.

Still referring to FIG. 3 and as stated above, the second channel 112extends at an angle relative to the central longitudinal axis x-x of theelongated body 102 and away from the first channel 110 in the proximaldirection. In the depicted embodiment, the second channel 112 comprisesa bend 132, which is curved in a direction away from the first channel110. The second channel 112 may comprise the bend 132 at any point alongthe length of the second channel 112 between the convergence area 130and the opening 125 on the elongated body 102. This bend 132 isstructured and configured to position/guide the semi-flexible drill bit116 through the angled second channel 112 and straight out of the distaltube or guide tip 128. Stated differently, the bend 132 curves thesemi-flexible drill bit 116 such that the drill bit 116 is at an anglecapable of exiting the distal tube or guide tip 128, which is alignedwith the first channel 110 (parallel to the central longitudinal axisx-x). As shown in FIG. 3, the proximal end 127 of the drill bit 116 isat an angle relative to the distal end 129 of the drill bit 116.

As shown in FIG. 3, the first channel 110 is substantially straightalong the bottom of the elongated body 102. When the drill bit 116 is inthe drill configuration, the drill bit 116 extends through theconvergence area 130 and out of the distal tube or guide tip 128. In thepre-drill configuration (shown in FIG. 1) and drill configuration, theanchor driver 114 and suture anchor 10 is proximal the convergence area130 in the first channel 110. Without obstruction by the anchor driver114 (and suture anchor 10) in the convergence area 130, the drill bit116 is free to pass via the second channel 112 through the convergencearea 130 and out of the distal tube and guide tip 128. However, thefirst channel 110 is aligned with the convergence area 130 and thedistal tube and guide tip 128 such that the anchor driver 114 can beeasily extended through the convergence area 130 and the distal tube andguide tip 128 without moving the assembly 100 (after the drill bit 116has been removed). The suture anchor 10 is less likely to miss thepreviously drilled hole, and is more likely to be inserted in the pilothole without adjusting the distal end 131 of the distal tube and guidetip 128 to sufficiently line up the pilot hole for deployment of thesuture anchor 10. Accordingly, if the position of the assembly 100 ismaintained with respect to the bone after the pilot hole has beendrilled, the suture anchor 10 with passing filament 11 should be able tobe easily delivered into the previously formed pilot hole without havingto move or change the angle of the distal tube and guide tip 128 tolocate the pilot hole.

Turning now to FIG. 4, there is shown is a close-up cross-sectionalfirst side 103 view schematic representation of a locking mechanism 133of the multi-barrel drill guide and anchor deployment assembly 100 ofFIG. 2. In the depicted embodiment, the locking mechanism 133 comprisesthe drill bit 116, the opening 123 on the sliding inserter 118 and theopening 125 on the elongated body 102. When the drill bit 116 extendsthrough both openings 123, 125 such that the distal end 129 of the drillbit 116 passes through at least a portion of the second channel 112 (andthe elongated body 102) and the proximal end 127 of the drill bit 116remains outside or exterior to the elongated body 102, the drill bit 116functions as a locking mechanism 133. The drill bit 116 maintains theopenings 123, 125 in alignment and thereby blocks the sliding inserter118 from advancing in the distal direction along the track 113. Thus,the user can operate the drill bit 116 to drill the pilot hole withoutrisking unintentional movement of the anchor driver 114 (and the sutureanchor 10).

Referring now to FIGS. 5-6, there are shown first side 103 and secondside 105 views of an illustrative embodiment of the locking mechanism133. First, FIG. 5 shows a cross-sectional front/perspective view of thelocking mechanism 133 on the first side 103 of the assembly 100. In thedepicted embodiment, movement of the sliding inserter 118 along thetrack 113 between the first side 103 and the interior of the second side105 of the assembly 100 is blocked or otherwise prohibited when thedrill bit 116 extends through the opening 123 in the sliding inserter118 and the opening 125 in the elongated body 102. Movement of thesliding inserter 118 is thus contained to movement parallel to thecentral longitudinal axis x-x by the track 113 and is either permittedor obstructed by the absence or presence, respectively, of the drill bit116.

Next, FIG. 6 shows a close-up second side 105 view of a notch 134 of thelocking mechanism 133 on the assembly 100 according to an additionalembodiment of the locking mechanism 133. In the depicted embodiment, thelocking mechanism 133 additionally comprises a notch 134 on the secondside 105 of the assembly 100. As shown, the notch 134 extends outwardfrom the elongated body 102. The notch 134 is configured to engage withan aperture 135 in the sliding inserter 118. In the depicted embodiment,the notch 134 and the corresponding aperture 135 are rectangular;however, any other compatible configurations of the notch 134 andaperture 135 may be used.

Still referring to FIG. 6, in the pre-drill configuration (FIG. 1) andthe drill configuration (FIGS. 2-3), the aperture 135 is engaged withthe notch 134. In particular, the aperture 135 surrounds the notch 134.When the drill bit 116 is removed from the assembly 100, the useradvances the sliding inserter 118 or otherwise applies force to theproximal end 119 of the sliding inserter 118 in the distal direction.Such force causes the aperture 135 of the sliding inserter 118 to slidepast the notch 134 on the elongated body 102. The sliding inserter 118may then continue to advance in the track 113 to place the suture anchor10 in the pilot hole. To reset the assembly 100 (i.e., reload theassembly 100 with a new suture anchor), the user moves the slidinginserter 118 along the track 113 in the proximal direction until theaperture 135 of the sliding inserter 118 engages or otherwise locks overthe notch 134 on the elongated body 102. When the notch 134 is alignedwith the aperture 135, the opening 123 in the sliding inserter 118 isaligned with the opening 125 in the elongated body 102. When theassembly 100 is reset and the aperture 135 is locked over the notch 134,the sliding inserter 118 cannot move any farther in the proximaldirection.

Turning now to FIG. 7, there is shown a first side 103 view schematicrepresentation of a multi-barrel drill guide and anchor deploymentassembly 100 in the post-drill, pre-anchor deployment, pre-actuatedconfiguration according to an embodiment. In the pre-drill and drillconfigurations shown in FIGS. 1-3, a suture anchor 10 has beenpre-loaded onto the distal end 115 of the anchor driver 114 of thesliding inserter 118. In such configurations, the distal end 115 of theanchor driver 114 (with the suture anchor 10) extends through the firstchannel 110 up to the convergence area 130, but not into the convergencearea 130. After the pilot hole has been drilled and the drill bit 116has been removed, as shown in the post-drill configuration of FIG. 7,the anchor driver 114 (with the suture anchor 10) is free to movethrough the convergence area 130 and out of the distal tube and guidetip 128.

Referring briefly to FIG. 8, there is shown a close-up cross-sectionalfirst side 103 view schematic representation of the second channel 112of the multi-barrel drill guide and anchor deployment assembly 100 ofFIG. 7. In the depicted embodiment, the drill bit 116 has been removedfrom the assembly 100 after the pilot hole has been drilled. As alsoshown in FIG. 7, the anchor driver 114 is free to advance along thefirst channel 110 via the sliding inserter 118. The sliding inserter 118is free to move in the distal direction along the track 113 because thedrill bit 116 is no longer in place to act as the locking mechanism 133between the sliding inserter 118 and the elongated body 102.

Turning now to FIG. 9, there is shown a close-up first side 103 viewschematic representation of a shallow deployment button 136 ofmulti-barrel drill guide and anchor deployment assembly 100 in thepre-actuated/undeployed configuration according to an embodiment. Ashallow deployment button 136 is located between the proximal end 104and the distal end 106 of the elongated body 102. In the depictedembodiment, the shallow deployment button 136 is located or otherwisepositioned within a recess 137 on the first side 103 of the elongatedbody 102. However, the shallow deployment button 136 may be positionedat other appropriate locations along the elongated body 102. As shown inFIG. 9, the shallow deployment button 136 is substantially flush withthe first side 103 of the elongated body 102 to prevent potentialinterference with use of the assembly 100 before the suture anchor 10 isdeployed.

Still referring to FIG. 9, the shallow deployment button 136 is hingedlyconnected to the elongated body 102 within the recess 137. In thedepicted embodiment, one side of the shallow deployment button 136 isconnected to the elongated body 102 via a hinge 138 in the recess 137.In the pre-actuated/undeployed configuration (shown in FIG. 9), theshallow deployment button 136 has a flange 139 which extends from therecess 137 into the first opening 107 (formed in the top of the handle108 and/or in the elongated body 102). In particular, the flange 139extends into the path of the track 113.

Referring now to FIG. 10, there is shown a close-up cross-sectionalsecond side 105 view schematic representation of the shallow deploymentbutton 136 of the multi-barrel drill guide and anchor deploymentassembly of FIG. 9. In a post-drill configuration, as described above,the sliding inserter 118 is free to advance along the track 113. Thesliding inserter 118 moves along the track 113 until a portion 140 ofthe sliding inserter 118 contacts the flange 139 of the shallowdeployment button 136, which extends into the path of the track 113, asshown in FIG. 9.

Turning now to FIG. 11, there is shown a close-up first side 103 viewschematic representation of the shallow deployment button 136 ofmulti-barrel drill guide and anchor deployment assembly 100 in theactuated/undeployed configuration according to an embodiment. After theportion 140 of the sliding inserter 118 contacts the flange 139 of theshallow deployment button 136 in FIG. 10, continuing to advance thesliding inserter 118 in the distal direction causes the portion 140 ofthe sliding inserter 118 to apply force on the flange 139. Force on theflange 139 rotates the shallow deployment button 136 about the hinge138, thereby rotating the shallow deployment button 136 out from therecess 137 to an actuated/undeployed configuration. The portion 140 ofthe sliding inserter 118 applies force on the flange 139 until theflange 139 is rotated out of the path of the track 113. With the flange139 out of the path of the track 113, the sliding inserter 118 canadvance farther distally along the track 113 to insert the suture anchor10 into the pilot hole. When the flange 139 is out of the path of thetrack 113, the passing filament 11 extends in the first channel 110 andfirst opening 107 between the flange 139 and a feature 142 in the firstopening 107 of the elongated body 102.

Referring now to FIGS. 12-13, there is shown a close-up rear/perspectiveview and rear view schematic representations of the shallow deploymentbutton 136 of FIG. 11. FIGS. 12-13 show the shallow deployment button136 in the actuated/undeployed configuration after it is rotated fromthe recess 137. The shallow deployment button 136 comprises an indicator141 which provides instructions for the user. In the depictedembodiment, the indicator 141 is an arrow pointing downward toward thefeature 142 on the elongated body 102. In order to deploy and releasethe suture anchor 10 from the assembly 100, the user will press theshallow deployment button 136 downward toward the feature 142 (i.e., inthe direction of the indicator 141) (as described in detail below).

Turning now to FIGS. 14-15, there is shown a first side 103 view andclose-up rear view schematic representations of the anchor driver 114 ofthe multi-barrel drill guide and anchor deployment assembly 100 in theactuated/undeployed configuration according to an embodiment. When theflange 139 is rotated out of the path of the track 113, the slidinginserter 118 can advance along the track 113 in the distal direction. Asthe sliding inserter 118 moves in the distal direction, the anchordriver 114 connected thereto also moves in the distal direction out ofthe distal tube and guide tip 128, as shown in FIG. 14. The anchordriver 114 (and the sliding inserter 118) are advanced until the sutureanchor 10 loaded on the distal end 115 of the anchor driver 114 is fullyinserted in the pilot hole. When the sliding inserter 118 is advanced asfar as possible, a proximal end surface 143 of the sliding inserter 118is substantially flush with a proximal end surface 144 of the elongatedbody 102, as shown in FIG. 15. The substantial alignment of the proximalend surface 143 of the sliding inserter 118 and the proximal end surface144 of the elongated body 102 provides confirmation to the user that thesuture anchor 10 is fully inserted in the pilot hole.

Referring now to FIG. 16, there is shown a close-up first side 103 viewschematic representation of the proximal ends 104, 119 of the elongatedbody 102 and sliding inserter 118 of FIG. 14. In the depictedembodiment, the suture anchor 10 on the distal end 115 of the anchordriver 114 has been fully inserted into the pilot hole. As such, theproximal end surface 143 of the sliding inserter 118 is substantiallyflush with the proximal end surface 144 of the elongated body 102. Asshown in FIG. 16, the portion 140 of the sliding inserter 118 comprisesa shallow channel 145. In the actuated/undeployed configuration shown,the shallow channel 145 is substantially aligned with the hinge 138above the feature 142 on the elongated body 102. When the shallowchannel 145 is substantially aligned with the hinge 138 above thefeature 142, the user can press or otherwise apply pressure/forcedownward on the shallow deployment button 136 toward the feature 142 (inthe direction of the indicator 141). The shallow deployment button 136moves downward via the hinge 138 and through the shallow channel 145toward the feature 142 to deploy the suture anchor 10.

Turning now to FIG. 17, there is shown a close-up first side 103 viewschematic representation of the suture anchor 10 in the undeployed stateon the anchor driver 114 of the multi-barrel drill guide and anchordeployment assembly 100. In the depicted embodiment, the suture anchor10 is shown in the undeployed state loaded on the anchor driver 114(extending from the distal tube or guide tip 128). In the particularembodiment of the suture anchor 10 in FIG. 17, the suture anchor 10comprises a first arm 12 and a second arm 13 which extend proximallytoward the distal tube or guide tip 128 in the undeployed state.

Referring now to FIG. 18, there is shown a first side 103 view schematicrepresentation of the shallow deployment button 136 of multi-barreldrill guide and anchor deployment assembly 100 in the actuated/deployedconfiguration according to an embodiment. After the anchor driver 114has been fully advanced and the suture anchor 10 has been fully insertedinto the pilot hole, the suture anchor 10 must be deployed and thenreleased from the assembly 100. To deploy the suture anchor 10, the userpresses or otherwise applies force downward on the shallow deploymentbutton 136 (in its actuated/undeployed configuration), as describedabove, resulting in the actuated/deployed configuration as shown in FIG.18.

Turning now to FIG. 19, there is shown a close-up side/rear perspectiveview schematic representation of the shallow deployment button 136 ofFIG. 18. When the shallow deployment button 136 is pressed downwardthrough the shallow channel 145 toward the feature 142 of the elongatedbody 102, the flange 139 presses or otherwise displaces the passingfilament 11 toward the feature 142, creating a new, longer path for thepassing filament 11. In the depicted embodiment, the assembly 100 has anadditional indicator window 146 formed in the handle 108 (and/or in theelongated body 102). The indicator window 146 comprises a shallowdeployment clicker 147 and a ridge 148. The shallow deployment button136 is connected to the shallow deployment clicker 147 such that whenthe shallow deployment button 136 is pressed downward to theactuated/deployed configuration, the shallow deployment clicker 147deflects over the ridge 148 in the indicator window 146, which isvisible to the user. In an additional embodiment, movement of theshallow deployment clicker 147 over the ridge 148 in the indicatorwindow 146 causes an audible noise (e.g., click), providing anadditional indication to the user that the shallow deployment button 136is in the actuated/deployed configuration and the suture anchor 10 hasreached the deployed state.

Referring now to FIG. 20, there is shown a close-up first side 103 viewschematic representation of the suture anchor 10 in the deployed stateon the distal end 115 of the anchor driver 114 of the multi-barrel drillguide and anchor deployment assembly 100. From the undeployed state(shown in FIG. 17), actuation and deployment of the shallow deploymentbutton 136 displaces the path of passing filament 11, effectivelyremoving slack and pulling the passing filament 11 in the proximaldirection. When the passing filament 11 is pulled in the proximaldirection, the first arm 12 and the second arm 13 of the suture anchor10 rotate in the distal direction toward each other (as the anchor isprevented from being pulled proximally by a force imparted in theopposite direction by the distal end of the anchor driver), as shown inFIG. 20 (and described below with reference to FIGS. 22-29). This causesthe suture anchor 10 to fold itself further into the pilot hole andcreate a wedge which is wider than the drill diameter and locks thesuture anchor 10 into place.

Turning now to FIG. 21, there is shown a close-up first side 103 viewschematic representation of the suture anchor 10 of FIG. 20 with themulti-barrel drill guide and anchor deployment assembly 100 removed. Inthe deployed state, as shown in FIGS. 20-21, the suture anchor 10 isremoved from the assembly 100 by unwrapping or otherwise dislodging thepassing filament 11 from the one or more notches 121 and the flexibleblock 122 at the proximal end 119 of the sliding inserter 118.

Referring now to FIGS. 22-29, there are shown various views schematicrepresentations of an embodiment wherein the suture anchor 10 is ashallow Y-Knot®. One such suture anchor is disclosed in U.S. patentapplication Ser. No. 15/687,040 assigned to the assignee hereof andincorporated by reference herein in its entirety. The suture anchor 10of the shallow Y-Knot® embodiment illustrated in FIGS. 22-29 is afibrous construct (anchor body) 20 having at least one passing filament21 weaved therethrough. The fibrous construct 20 has a first arm 22 anda second arm 23 (as the first and second arms 12, 13 shown in FIG. 17)with a proximal side 24 and a distal side 25 extending therebetween. Thepassing filament 21 has a first end 26 and a second end 27 woven throughthe fibrous construct 20 in a T-shape in the undeployed (orpre-deployment) configuration. Importantly, the fibrous construct 20 isthicker than the passing filament 21, providing greater tensile strengthto the fibrous construct 20 (as compared to the filament 21) to minimizecreep toward the top/proximal end of the pilot hole. If more tension isplaced on the passing filament 21, the fibrous construct 20 isconfigured to and will widen and wedge into the bottom of the pilot holeto lock in place (based on the particular placement of the passingfilament 21 through the fibrous construct 20, the force and locationthereof imparted by the deployment device (e.g., anchor driver 114) onthe fibrous construct 20, and the characteristics of the fibrousconstruct 20 itself).

FIG. 23 shows one embodiment for passing locations 28 on the fibrousconstruct 20. As shown, the passing filament 21 enters and exits theproximal side 24 and distal side 25 of the fibrous construct 20 at aplurality of passing locations 28. The fibrous construct 20 is thenloaded onto an anchor deployment device/inserter, such as the anchordriver 114 described above. Importantly, the fibrous construct 20 ispositioned within the anchor driver 114 such that the first end 26 ofthe filament 21 extends along a first side 29 of the anchor driver 114and second end 27 of the filament 21 extends along a second side 30 ofthe anchor driver 114.

Deployment of the fibrous construct 20 is further described andillustrated with reference to FIGS. 24-29. As shown in FIG. 24, thefibrous construct 20 is implanted by the anchor driver 114 into apreformed pilot hole 31. Once the fibrous construct 20 is loaded ontothe anchor driver 114 (or other deployment device), the anchor driver114 is used to push the fibrous construct 20 into a narrow preformedpilot hole 31 (e.g., 10 mm deep). Such a narrow pilot hole 31 is oftenformed in smaller bones by necessity, such as those in extremities.

When the fibrous construct 20 enters the narrow pilot hole 31, the firstarm 22 and second arm 23 of the fibrous construct 20 begin to fold orotherwise bend in the proximal direction the narrow width of the pilothole 31, as shown in FIG. 24 (also shown in FIG. 17). Then, to deploythe fibrous construct 20, the anchor driver 114 is held in place, fullyinserted in the pilot hole 31, while the first and second ends 26, 27 ofthe passing filament 21 are tensioned and pulled away from the fibrousconstruct 20 in the proximal direction. When the first and second ends26, 27 of the passing filament 21 are pulled, lengths of fibrousconstruct 20 between each of the passing locations 28 are pulled closertogether as slack in the passing filament 21 between the passinglocations 28 is minimized. Meanwhile, as a result, the first arm 22 andthe second arm 23 of the fibrous construct 20 begin to rotate in thedistal direction, as shown in FIG. 25.

To continue deployment of the fibrous construct 20, the first and secondends 26, 27 of the passing filament 21 are pulled farther and farther inthe proximal direction away from the fibrous construct 20 and additionalslack of the passing filament 21 between the passing locations 28 in thefibrous construct 20 is reduced. As a result, the first and second arms22, 23 of the fibrous construct 20 continue to fold or otherwise bendtighter in the distal direction, as shown in FIGS. 26-27, and pleats 32begin to form between adjacent passing locations 28. Due to the addedtension, the first and second arms 22, 23 of the fibrous construct 20are pulled closer together toward the central longitudinal axis x-xthrough the fibrous construct 20. As an additional result, the pleats 32become more defined, as shown in FIG. 28.

Thereafter, the first and second ends 26, 27 of the passing filament 21are pulled until there is no remaining slack between adjacent passinglocations 28 in the fibrous construct 20, as shown in FIG. 29 (and FIG.21). Applying additional tension to the first and second ends 26, 27 ofthe passing filament 21 strengthens the fibrous construct 20 by forcingthe fibrous construct 20 to widen or expand inside the pilot hole 31until it reaches a fully deployed configuration, as shown in FIG. 29. Asthe fibrous construct 20 is compressed or gets shorter, the fibrousconstruct 20 expands in directions perpendicular to its length (i.e.,width or thickness) to set and secure the anchor in place in the pilothole 31.

The pleats 32 form a stack of the mattress thicknesses effectivelyincreasing a diameter (as measured in relation to the centrallongitudinal axis x-x of the fibrous construct 20 and the pilot hole31). This relative increase in size in distance from the centrallongitudinal axis x-x of the pilot hole 31 creates a retention force ofthe fibrous construct 20, including the expansion in width and/orthickness described above. In other words, Poisson's ratio of widthand/or mattress thickness growth during a reduction in length providesfor an increase in deployment size that is additive to the increase dueto the pleats 32 force of the fibrous construct 20. Poisson's ratiodefines the proportional decrease in a longitudinal measurement to theproportional increase in length in a sample of material that iselastically stretched. Therefore, if a material is compressed in thex-direction, for example, the material will expand in the y-directionand/or z-direction.

The passing filament 21 can be removed from the fibrous construct 20 bypulling either end 26, 27 until the entire passing filament 21 isremoved. The final form of the fibrous construct 20 in the deployedstate allows the passing filament 21 to easily slide therethrough, asthe fibrous construct 20 is set and secured in the pilot hole 31. Thatis, the tensile strength of the fibrous construct 20 in thisconfiguration is sufficient to keep the fibrous construct 20 in placewhile the passing filament 21 is easily removed.

Deployment of the fibrous construct 20 is further described andillustrated with reference to FIGS. 29A-29C, in accordance with analternative embodiment. FIG. 29A shows the fibrous construct 20 in asimilar undeployed position as the fibrous construct 20 in FIG. 24. FIG.29B shows the fibrous construct 20 in a position about half way to fulldeployment, and FIG. 29C shows the fibrous construct 20 in a fullydeployed configuration. The main difference between the embodimentsshown in FIGS. 24-29 and the embodiments shown in 29A-29C, includes theslack line that runs across the side of the inserter 114 (no. “21”written on the line) in FIG. 29A, for example, where the slack line runsacross the distal end and partially inside the forked section of theinserter 114 in FIG. 24. Other positioning configurations of the passingfilament 21 through the fibrous construct 20, which allow the fibrousconstruct to perform the same or similar functionality are contemplatedand within the scope of this disclosure (as should be appreciated by aperson of ordinary skill in the art in conjunction with a review of thisdisclosure).

Turning now to FIGS. 30-36, there are shown various views schematicrepresentations of an embodiment of the multi-barrel drill guide andanchor deployment assembly 100 wherein the suture anchor 10 is a Y-Knot®anchor 40, for example, which can be any all suture anchor configured toperform the same functionality as described herein (as should beunderstood by a person of ordinary skill in the art in conjunction witha review of this disclosure). FIG. 30 shows the assembly 100 with a 1.3mm or 1.8 mm Y-Knot® all suture anchor. One such suture anchor isdisclosed in U.S. Pat. No. 9,826,971 assigned to the assignee hereof andincorporated by reference herein in its entirety. In the depictedembodiment and as described above, the drill bit 116 is loaded in thesecond channel 112 into the convergence area 130 such that the drill bit116 acts as the locking mechanism 133 to ensure that the slidinginserter 118 will not move in transportation or during handling untilthe drill bit 116 is used and removed. In the depicted embodiment of theassembly 100 shown in FIG. 30, in addition to having a different allsuture anchor, the assembly 100 does not have the shallow deploymentbutton 136 or shallow deployment clicker 147 of the embodiment of theassembly 100 of FIGS. 1-22. Otherwise, the assembly 100 is the same asthe assembly 100 described and illustrated with respect to FIGS. 1-20.

FIG. 31 shows the drill bit 116 after it has drilled the proper depthfor a pilot hole in a bone. As with other embodiments of the assembly100, the user will know the proper depth has been reached because thedepth stop 126 on the drill bit 116 will contact the opening 123 of thesliding inserter 118. FIG. 32 shows the assembly 100 after the drill bit116 has been removed. The sliding inserter 118 is now free to be advancealong the track 113 and insert the Y-Knot® 40 into a pilot hole. FIG. 33shows the assembly 100 after the all suture anchor 40 is fully insertedinto the pilot hole and deployed, while FIG. 34 shows the all sutureanchor 40 deployed after the assembly 100 is removed.

An embodiment of the Y-Knot® anchor (or soft anchor or “all-suture”anchor) 40 is illustrated in detail in FIGS. 35-36. The all sutureanchor 40, as shown in FIGS. 35-36, contains at least two sections: atleast one filament 41, which is a suture to be anchored; and a fibrousconstruct (anchor body) 40, which is to form a portion of the anchorthat can increase in width, thickness and/or diameter and shrink inlength as part of deployment. See FIG. 35, showing the fibrous construct40 in the undeployed state; and FIG. 36, showing the fibrous construct40 “shortened” and “expanded” in the deployed state, which is additiveto the increase due to the pleats). This soft anchor embodiment alsotakes advantage of Poisson's ratio, which captures the followingcause/effect relationship: compressing a material in a first directioncauses the material to expand in direction perpendicular to the firstdirection (i.e., if compressed in the x-direction, the material willexpand in the y-direction and/or z-direction), andstretching/lengthening a material in a first direction causes thematerial to contract in directions perpendicular to the first direction.Although, it is the fibrous construct 40 that increases in width,thickness and/or diameter at deployment, it should be understood thatthe filament 41 also plays a role in the deployment of the anchor eventhough the filament 41 may remain free (in some embodiments) to slide,and non-slidable in others (at least at a particular position or pointin use) in relation to the fibrous construct 40. The filament 41 helpsto position, align and support the fibrous construct 40, such that ifthe filament 41 were to be removed from the fibrous construct 40 afterdeployment of the anchor, the fibrous construct 40 may be free to spill(i.e., release), allowing the fibrous construct 40 to collapse andshrink in size, allowing for easy (and potentially undesirable) removal.

In other words, the fibrous construct 40 has two primary functions.First, it becomes a base for the filament 41 to slide within. Second,when compressed and/or pleated during deployment, the fibrous construct40 becomes more compact in one direction thereby expanding outwardly andincreasing its overall width, thickness or diameter to create aretention capacity. This action of having the fibrous construct 40change in shape to increase its overall width, thickness or diameter isa useful characteristic which may be used advantageously to secure theanchor in a hole or against a bony or soft tissue. It is thiscombination of the expanding fibrous construct 40 coupled with thefilament 41 remaining slidable (in some embodiments: and non-slidable inothers, at least at a particular position or point in use) in relationto the fibrous construct 40 that render embodiments of the presentinvention ideal for the reattachment of soft tissue to bone or softtissue to soft tissue where it is desirable to pass sliding knots tosecure a repair.

The discussion below relates to alternative embodiments of a disposabledrill, and of two different anchor drivers.

Turning to FIG. 37, a side view schematic representation of a disposabledrill 300 with a pre-installed drill bit 302 according to an alternativeembodiment is shown. This disposable drill 300 and pre-installed drillbit 302 may be used in place of drill bit 116, described above, orseparately/independently therefrom. The disposable drill can include,but is not limited to, a motor 301, a drill bit 302 attached to themotor with a specified/predetermined length so that it is configured tocreate an pilot hole with a desired length/depth for a particularprocedure, disposable batteries 303 configured to supply power to themotor, and at least one switch 304 configured to be actuated(rotationally, linearly, perpendicular to the longitudinal axis of thedevice (“pushed”)) by a user to turn on the drill bit 302, and/or setthe desired speed of the drill bit 302. The disposable drill 300 canalso include a disposable plastic housing 305 to make the devicelightweight, less expensive, and disposable. The disposable plastichousing 305 can be made from any plastic or combination of plastics.

As discussed above, during suture anchor placement, a pilot hole istypically made in bone before an anchor is inserted. The pilot hole istypically formed by using a drill bit to drill a hole for placement ofthe anchor. However, conventionally, a drill handpiece and battery mustbe sterilized and ready for use in the surgery. Also, a drill bit istypically drilled a certain depth through a drill guide, so a hard stopstructure can be required on the drill guide, or a hard stop structurecan be placed on the drill handpiece at a certain location to create anappropriate hard stop against the drill guide (as should be understoodby a person of ordinary skill in the art in conjunction with a review ofthis disclosure).

By providing disposable drill 300 in accordance with an embodiment,there is no need for an additional drill handpiece and battery to besterilized before the surgery. Also with the drill bit 302 pre-installedon the disposable drill 200, the disposable drill 300 is ready to useout of the package and does not require the additional step ofinstalling of the drill bit on the drill handpiece.

Generally, the following described and illustrated two alternativedriver designs are configured to work based on the same concept ofpulling suture tails back/proximally from an anchor to deploy the anchor(see, e.g., FIGS. 18-21 and related description). The alternative driverdesigns may be used in place of the anchor driver 114, described above,or separately/independently therefrom. Each of the following describedand illustrated anchor driver devices works with an all suture softtissue fixation device with a suture that is configured to slide afterthe anchor is deployed. In many procedures that involve soft tissuefixation in the extremities, it is necessary to have an anchor that canbe deployed in a relatively shallow hole with a narrow diameter (ascompared with other locations in the body). The uniqueness of the allsuture soft tissue fixation device pertains, in part, to the weaving ofthe suture through the anchor which allows the anchor to sufficientlydeploy in the bone tunnel (preferably at the bottom of the bone tunnel)while the driver is still inserted. The pattern which the suture isweaved through the anchor is unique in that it preferably does not startand end at the tips of the anchor (although, it can do so). Instead, itis started very close to the center and woven to the tip at one end thenfrom there to the opposite tip and woven back to the center next to thestarting position. Such a configuration is illustrated in the FIG. 38.As shown, the all suture soft tissue fixation device includes a fibrousconstruct (anchor body) 20 (e.g., no. 5 suture) having at least onepassing filament 21 (e.g., no. 0 suture) weaved therethrough, similar tothe suture anchor 10 of the shallow Y-Knot® embodiment illustrated inand described with respect to FIGS. 22-29. The weaving of thesuture/filament 21 through the fibrous construct 20 allows the anchor todeploy while still on a driver by tensioning the first and second ends26, 27 of the passing filament 21 (similarly to FIGS. 18-21, 25-29, asdescribed above, and below). The design of the driver allows insertionof the anchor into the bone tunnel without use of an additional guide,and deploys the anchor quickly by an actuation means (e.g., by squeezingor depressing of a lever). After deploying the anchor, the driver can beremoved and the suture can slide through the anchor. FIGS. 39-56illustrate one alternative embodiment of an anchor driver 200, and FIGS.57-62 illustrate another alternative embodiment of an anchor driver 400.

Turning to FIG. 39, there is shown a side perspective view of analternative embodiment of an anchor driver 200. The anchor driver 200can include, but is not limited to, a forked distal driver tip 201 toposition a suture anchor 10 in a bone hole (not shown). A depth stop 202is positioned proximally of the forked distal driver tip 201, and isconfigured to ensure that the driver is inserted a predetermined depthinto the bone hole (e.g., 10 mm). A lever arm 203 is shown, which isconfigured to displace suture attached to the anchor 10 in order todeploy the anchor 10 (described below). A spool retaining arm 206 isalso shown, and is configured to keep a suture spool 205 (detailedbelow) in a locked position until the spool 205 is intentionallyreleased by a user. The anchor driver 200 can include a housing/cover(not shown) to cover the internal parts. The anchor driver 200 is shownopen without a housing/cover to allow for illustration of the internalparts.

Turning to FIG. 40, a slot 207 is provided in the anchor driver 200 inwhich spool 205 sits. The slot 207 includes teeth 207A configured toengage and lock with teeth 205A of the spool (FIG. 41) when the spool205 is fully inserted into a locked position (described below). Thespool retaining arm 206 is also configured to engage and lock with teeth205A of the spool (FIG. 41) when the spool 205 is fully inserted into alocked position. A perspective view of the spool 205 is shown in FIG.41, and includes portions to wind suture 205B, 205C, and teeth 205A.

Referring to FIGS. 42 and 43, perspective views of the safety bar 204alone and positioned within the anchor driver 200, respectively, areshown. As shown in FIG. 43, the anchor driver 200 is fully assembled(except for an optional housing/cover), and the spool 205 is shown inthe locked position where the lateral surface 208 is positioned out apredetermined distance from the side 209 of the anchor driver 200. Inthe locked position, a portion of teeth 207A of the slot 207 ispositioned in contacting relation with a portion of teeth 205A of thespool 205, and the spool retaining arm 206 is positioned between anotherportion of teeth 205A of the spool 205. In addition, the safety bar 204is shown positioned is a slot of the anchor driver 200 under the leverarm 203 (which is configured to block the lever arm from contacting thesuture limbs 26 and 27). The anchor 10 is also shown positioned on theforked distal driver tip 201.

FIG. 44 is a top perspective view of the distal end of the anchor driver200 showing the anchor 10 positioned on the forked distal driver tip 201(in an undeployed configuration/position) and ready for insertion into abone hole.

FIG. 45 is a side perspective view of the spool 205 in the lockedposition (as described above). As shown, the lateral surface 208 ispositioned out a predetermined distance from the side 209 of the anchordriver 200 to form a spool release button.

FIG. 46 is a side perspective view of the spool 205 in theunlocked/released position, where the lateral surface 208 has beenpushed/actuated by a user to be substantially flush with the side 209 ofthe anchor driver 200. This position of the spool 205 releases the teeth205A of the spool 205 from the teeth 207A of the slot 207 and from thespool retaining arm 206, allowing the spool 205 to freely spin andunwind the suture.

A method of using anchor driver 200 will now be described. In brief, theanchor driver 200 is preferably configured to be a single use device,and is packaged as shown in FIG. 47 (showing a side perspective view ofanchor driver 200 in an undeployed configuration). After drilling a bonehole/tunnel (e.g., a 10 mm deep and 1.5 mm diameter hole), anchor driver200 is then inserted into the bone tunnel by striking the back of thedriver (as should be understood by a person of skill in the art inconjunction with a review of this disclosure). When the built in depthstop 202 is flush with the top surface of the bone, the safety bar 204can be removed and the lever arm 203 is squeezed to deploy the anchor 10(see FIGS. 48-54). After the anchor 10 is deployed, the lateral surface208 of the spool 205 is pushed in to be flush with the side surface 209of the driver body, and the driver 200 is removed from the insertionsite (FIG. 55). By removing the driver 200 while holding the spool 205in the released position, the suture tails 26, 27 will unspool and freethemselves from the driver (FIG. 56).

Turning to FIG. 48, the safety bar 204 is shown removed (after theanchor 10 is preferably fully inserted into a bone hole) to allowdeployment of the anchor 10.

Referring to FIG. 49, the lever arm 203 is actuated/pressed down by auser (similar to the embodiment shown and described with respect toFIGS. 18-21), which deflects the suture tails 26, 27 (only from theanchor/distal side and not the spool proximal side because of the spoolbeing in the locked position) to deploy the anchor 10.

Turning to FIG. 50, the tails of the anchor 10 are shown beginning toflip and point in the opposite/distal direction, as the suture 21 slackis taken out of the anchor by depressing the lever arm 203.

Turning to FIGS. 51 and 52, the lever arm 203 is shown being depressedabout half way over the suture limbs 26, 27, further deploying theanchor 10.

Turning to FIGS. 53 and 54, the lever arm 203 is shown fully depressedover the suture limbs 26, 27, fully deploying the anchor 10 (preferablyat the base of the bone hole).

Turning to FIG. 55, the lateral surface 208 of the spool 205 is shownpushed in to be flush with the side surface 209 of the driver body, andthe driver 200 is removed from the insertion site which unspools thesuture.

Referring to FIG. 56, the anchor 10 is shown in its fully deployed state(preferably at the bottom of a bone hole) after the anchor driver 200 isremoved.

Turning to FIG. 57, there is shown a side perspective view of analternative embodiment of an anchor driver 400. The anchor driver 400can include, but is not limited to, a forked distal driver tip 401 toposition a suture anchor 10 in a bone hole (not shown). A depth stop 402is positioned proximally of the forked distal driver tip 401, and isconfigured to ensure that the driver is inserted a predetermined depthinto the bone hole (e.g., 10 mm). A lever arm 403 is shown, which isconfigured to displace suture attached to the anchor 10 in order todeploy the anchor 10 by pushing a sliding cleat 405 attached to theproximal end of the suture tails 26, 27 proximally through a channel orgroove 407 (further described below). A safety lever 404 is also shown,and is configured to prevent the actuation of the lever arm 403 untilwhen appropriate. A cleat release notch 406 is also shown, which isconfigured to stop the cleat 405 from freely falling out of the anchordriver 400 after the anchor 10 is deployed. As shown in FIG. 58, theanchor driver 400 can also include a housing/cover 408 to cover theinternal parts (although, the anchor driver 400 is shown open without ahousing/cover in many of these figures to allow for illustration of theinternal parts).

As shown in additional figures identified below, the lever arm 403 isconfigured to push the sliding cleat 405 back/proximally a predetermineddistance (e.g., about 10 mm, which is an example appropriate distance todeploy the anchor 10). After pushing the cleat 405 proximally apredetermined distance, the lever arm 403 is configured to be positionedfully outside the channel 407 of the sliding cleat 405. Because of this,the sliding cleat 405 is configured to freely slide up to the cleatrelease notch 406 at the distal end of the driver 400. At this point,the driver 400 can be removed from the insertion site and the cleat 405can be separated from the driver 400 with a pull on the suture tails 26,27.

A method of using anchor driver 400 will now be described. In brief, theanchor driver 400 is preferably configured to be a single use device,and is packaged as shown in FIG. 58 (showing a side perspective view ofanchor driver 200 in an undeployed configuration). After drilling a bonehole/tunnel (e.g., a 10 mm deep and 1.5 mm diameter hole), anchor driver400 is then inserted into the bone tunnel by striking the back of thedriver (as should be understood by a person of skill in the art inconjunction with a review of this disclosure). When the built in depthstop 402 is flush with the top surface of the bone, the lever arm 403can be actuated by a user (e.g., squeezed) which pushes the slidingcleat 405 proximally to tension the suture tails 26, 27 and deploy theanchor (see FIG. 60). With the lever arm 403 fully depressed, the driver400 can be removed from the insertion site and the sliding cleat 405 isconfigured to pull out from the front of the driver (see FIGS. 61, 62).Finally, the suture can be uncleated from the sliding cleat 405 and thesuture tails can be pulled to ensure that the anchor is deployed.

Turning to FIG. 59, the anchor driver 400 is shown in anundeployed/unactuated position, and is ready to deploy the anchor 10into a bone hole (not shown).

Referring to FIG. 60, the anchor driver 400 is shown after the lever arm403 has been actuated making it clear of the channel 407, and the anchor10 has been deployed.

Referring to FIG. 61, the sliding cleat 405 is shown positioned at therelease notch 406, having moved through the channel 407 after the driver400 has been removed from the insertion site.

Turning to FIG. 62, the sliding cleat 205 is shown completely removedfrom the driver 400 and is ready to be uncleated to the anchor 10through the suture tails 26, 27.

Referring now to FIGS. 63-65, there are shown top views schematicrepresentations of a hand 600 during various steps of a method forsuspending a first metacarpal 602 in relative position to a secondmetacarpal 604. In an exemplary procedure, a suspension arthroplasty forbasal thumb arthritis requires suspension of the CMC joint between thefirst metacarpal (i.e., thumb bone) 602 and the second metacarpal (i.e.,index finger bone) 604.

FIG. 63 shows a first step in the method for suspending the firstmetacarpal 602 in relative position to the second metacarpal 604. Asshown, a drill (not shown) is positioned on a lateral, first side 606 ofthe first metacarpal 602. An exemplary drill is the disposable drill300, shown in FIG. 37. The drill is used to drill a hole 608 through thelateral, first side 606 of the first metacarpal 602. The drilled hole608 is sized and configured to fit a drill guide 500. The drill guide500 can be any drill guide or combination drill guide and anchor driver.For example, the drill guide 500 in FIG. 63 can be the multi-barreldrill guide and anchor deployment assembly 100 shown in FIG. 1.

After the hole 608 is drilled in the first metacarpal 602, the drillguide 500 is inserted into the hole 608 from the lateral, first side 606of the first metacarpal 602. The drill guide 500 is advanced to alateral, first side 610 and surface 612 of the second metacarpal 604. Inthe preferred embodiment, the distal tube and guide tip 128 of themulti-barrel drill guide and anchor deployment assembly 100 is advancedthrough the first metacarpal 602 to a surface 612 of the secondmetacarpal 604.

Next, as shown in FIG. 64, an anchor (not shown) is inserted into thesecond metacarpal 604, after a hole is drilled therein (but notextending all the way through). While the anchor is inserted into thehole formed in the second metacarpal 604, it does not extend through thesecond metacarpal 604. The anchor can be any known suture anchors or theanchors described herein. For example, the anchor can be the shallowY-Knot anchor 20 illustrated in and described with respect to FIGS.22-29 (as the anchor 10 shown loaded onto the multi-barrel drill guideand anchor deployment assembly 100 in FIGS. 20-21). Further, the anchorcan be inserted into the second metacarpal 604 via an anchor driver 200,400, such as those shown in the embodiments illustrated in FIGS. 39-56and 57-62.

In the preferred embodiment, the anchor is inserted into the secondmetacarpal 604 using the multi-barrel drill guide and anchor deploymentassembly 100 of FIG. 1. The anchor is inserted as described above withreferences to FIGS. 10-17. Generally, the anchor driver 114 within thedistal tube and guide tip 128 has the suture anchor 10 loaded thereon(FIG. 14). The anchor driver 114 is advanced in the distal direction outof the distal tube and guide tip 128 until the anchor 10 is fullyinserted into the second metacarpal 604. In the embodiment shown in FIG.17, the passing filament 11 connected to the suture anchor 10 remainsconnected to the multi-barrel drill guide and anchor deployment assembly100 so that the suture anchor 10 can be tensioned and deployed.

Therefore, at the next step of the suspension method, the anchor withinthe second metacarpal 604 is deployed. The process for deploying theanchor may vary depending on the type of anchor used. In the preferredembodiment, the anchor is the shallow Y-Knot®, described above. Usingthe multi-barrel drill guide and anchor deployment assembly 100, theshallow deployment button 136 is pressed downward to deploy the anchor10, as shown in FIG. 18. As a result, the passing filament 11 istensioned (FIG. 19) (i.e., pulled in the proximal direction), causingthe suture anchor 10 (FIG. 20) to fold itself further into the secondmetacarpal 604 and create a wedge which is wider than the diameterwithin the second metacarpal 604 and locks the suture anchor 10 intoplace. With the anchor 10 in the deployed state, the multi-barrel drillguide and anchor deployment assembly 100 can be removed, as shown inFIG. 21 and described above.

FIG. 64 shows the hand 600 after the anchor is deployed and the drillguide 500 (FIG. 63) has been removed from the first metacarpal 602. Thedrill guide 500 has been removed such that suture 700 attached to theanchor, extends from the second metacarpal 604 and through the firstmetacarpal 602. To complete the procedure and suspend the firstmetacarpal 602 in relative position to the second metacarpal 604, thesuture 70X) must be tensioned and the tension must be fixed or otherwiselocked.

FIG. 65 shows an embodiment wherein a rigid button 702 is used to fixthe tension in the suture 700 between the first metacarpal 602 and thesecond metacarpal 604. However, the button 702 can be any suspensoryfixation device as described in U.S. Pat. No. 9,700,403 assigned to theassignee hereof and incorporated by reference herein in its entirety,any suture suspension system as described in U.S. patent applicationSer. No. 15/711,192, assigned to the assignee hereof and incorporated byreference herein in its entirety, and/or comprised of any soft sutureanchor material. In brief, an embodiment of the suspensory fixationdevice or suspension system can include an elongated anchor member (alsoreferred to as a “backstop,” which may or may not have preformed suturereceiving apertures, where at least one of which can, but doesn't haveto be, recessed within a surface of the elongated anchor member), and asuture threaded through at least one of the apertures. Additionally, thesuspensory fixation device or suspension system may be comprised ofradiopaque fiber so that the button 702 (or backstop) can be seen inx-ray photographs. A purpose of using an all-suture anchor and anall-suture button 702 (or backstop) is to minimize irritation anddiscomfort to the patient at the surgical site.

Referring now to FIG. 66, there is shown a side schematic viewrepresentation of an all-suture button (or backstop) 702 loaded onto thesuture 700. FIG. 66 is used for exemplary purposes to show how theall-suture button 702 is loaded onto the suture 700, which is connectedto and extends from the anchor 10. However, in the instant method forcreating suspension between the first and second metacarpals 602, 604,the anchor 10 is within the second metacarpal 604—not on a medial,second side 614 thereof, as shown.

With the anchor 10 in the deployed state, the button 702 is moveddistally along the suture 700 until it is against the lateral, firstside 606 of the first metacarpal 602. Once the button 702 is against thelateral, first side 606 of the first metacarpal 602, additional tensionin the suture 700 causes the button 702 to move from an expandedposition to a compressed position. In the expanded position, ends of thebutton 702 are in a first direction along a longitudinal axis. When thebutton 702 moves into the compressed position, the ends of the button702 rotate to a second direction different than the first direction.Other compressed positions are contemplated in which the button 702covers a surface area on the lateral, first side 606 of the firstmetacarpal 602 greater than the diameter of the bone hole 608. Purposesof the button 702 structure, configuration, positioning and relatedfunctionality is to prevent the suture 700 from pulling out from thebone hole 608, to maintain the tension in the suture 700 between thebutton 702 and the anchor 10, and to suspend the first metacarpal 602 inrelative position to the second metacarpal 604.

Turning now to FIG. 67, there is shown a side schematic view of a knot704 formed in the suture 700 proximally over the button 702. Tying theknot 704 in the free suture 700 secures the button 702 in the compressedand deployed position. Excess portions of the suture 700 that extendfrom the knot 704 can be trimmed and removed to decrease the potentialfor irritation and discomfort.

In the embodiment shown in FIG. 65 wherein the button 702 is not anall-suture button 702, the knot 704 maintains the rigid button 702 inthe desired position, and the suture 700 at the desired tension, overthe bone hole 608.

In an alternative embodiment, after the suture 700 is appropriatelytensioned, the tension is fixed by tying the suture 700 to a ligament ortendon in the hand 600. Thus, the suspension of the first metacarpal 602and the second metacarpal 604 is created by tying a knot in the suture700 around a ligament or tendon in the hand 600.

Filaments and sutures, as the terms are used and described herein,includes braided (i.e., multi-filament) suture and monofilament sutureas well as any other metallic or non-metallic filamentary or wire-likematerial suitable for performing the function of a suture. This materialcan include both absorbable and non-absorbable materials.

While embodiments of the present invention has been particularly shownand described with reference to certain exemplary embodiments, it willbe understood by one skilled in the art that various changes in detailmay be effected therein without departing from the spirit and scope ofthe invention as defined by claims that can be supported by the writtendescription and drawings. Further, where exemplary embodiments aredescribed with reference to a certain number of elements it will beunderstood that the exemplary embodiments can be practiced utilizingeither less than or more than the certain number of elements.

What is claimed is:
 1. A method for suspending a first metacarpal inrelative position to a second metacarpal, comprising the steps of:drilling a hole through the first metacarpal; inserting a drill guidethrough the hole in the first metacarpal; advancing the drill guide to asurface of the second metacarpal, and drilling a hole in the secondmetacarpal; inserting an anchor into the hole formed in the secondmetacarpal, wherein the anchor is attached to suture; deploying theanchor within the second metacarpal; tensioning the suture attached tothe anchor; and fixing the position of the first metacarpal relative tothe second metacarpal using the suture.
 2. The method of claim 1,further comprising the steps of: attaching a fixation device to thesuture; and advancing the fixation device along the suture to over thehole in the first metacarpal.
 3. The method of claim 2, furthercomprising the step of deploying the fixation device over the hole inthe first metacarpal.
 4. The method of claim 2, further comprising thestep of tying a knot in the suture proximal to the fixation device. 5.The method of claim 1, wherein the step of fixing the position of thefirst metacarpal relative to the second metacarpal using the sutureincludes the step of tying a knot in the suture proximal to the hole inthe first metacarpal.
 6. The method of claim 1, wherein the step offixing the position of the first metacarpal relative to the secondmetacarpal using the suture includes the step of tying the suture to atleast one of a ligament or a tendon.
 7. The method of claim 1, whereinthe fixation device is an all-suture button.
 8. The method of claim 1,wherein the anchor is an all-suture anchor.
 9. The method of claim 1,wherein the drill guide comprises an anchor driver extendingtherethrough and the anchor is loaded onto the anchor driver prior toinsertion in the hole of the first metacarpal.
 10. The method of claim1, wherein the step of deploying the anchor within the second metacarpalincludes the step of pulling the suture in a proximal direction using afeature of the drill guide.